Governments are generally loath to alienate general practitioners. They fear that their discontented mutterings might inflame over 6 million patients a week. Now that the NHS is once more central to pre-election manifestos and voters’ concerns UK politicians of all parties are treading carefully.1

David Cameron recently reiterated his commitment to ensuring that GPs will be available to patients seven days a week between 8 am and 8 pm if his party is re-elected next year. Exactly how this can be achieved against a backdrop of increasing workforce shortages is unclear. Within days his health secretary was reassuring doctors that consultations could be undertaken by email, telephone, or Skype as well as face to face. Extended access is only the latest in a series of schemes designed to “relieve pressure on hospitals” while assuaging the public’s supposed desire for limitless primary care. Have any of them worked?

NHS Direct, a telephone helpline led by nurses, was established in 1998. Its introduction was associated with the halting of an upward trend in use of out of hours services, but the use of emergency departments or ambulance services did not fall in the medium or longer term.2